Talking to Vaccine Resisters

Measles, the most infectious microbe known to humanity, is making a comeback. On Monday, the Centers for Disease Control and Prevention updated its tally of measles infections for 2015 to a hundred and two. (Ninety-four of those are the result of an outbreak that began at Disneyland in mid-December.) There were more than six hundred measles infections in the U.S. in 2014, the highest total of any year since the disease was declared eliminated in this country a decade and a half ago.

It’s no mystery why this is occurring: increasingly, a dangerously high percentage of parents are choosing not to vaccinate against a disease that has killed more children than any other in history.

There are myriad reasons why these parents are willing to put their own children and the people around them at risk. (While the measles vaccine is overwhelmingly effective, infants don’t receive their first measles, mumps, and rubella, or M.M.R., shot until their first birthday, which means they’re vulnerable during the precise time when a measles infection is most dangerous.) Some continue to believe a fraudulent, retracted study by a disgraced gastroenterologist that posited a connection between the M.M.R. vaccine and autism. Others argue that “natural” immunity is somehow safer or better than vaccine-induced immunity, a bizarre and dangerous notion that ignores the fact that millions of lives have been saved by vaccines. There are parents who are convinced that children receive too many vaccines too early in their lives—despite the fact that the total viral load in pediatric vaccines today is a fraction of what it was thirty years ago. And there are those who simply say that vaccines don’t feel safe to them.

Efforts to combat these mistaken beliefs have made one thing clear: it’s much easier to scare people than it is to dispel fears, regardless of how dangerous and untrue they are. That’s not to say that it’s impossible to successfully communicate with parents who are anxious about vaccines. Unfortunately, the public-health community has very little clue as to how to do so—and they’ve been going about it the wrong way for years.

After my book “The Panic Virus,” about the vaccine-autism controversy and the modern-day anti-vaccine movement, came out in 2011, I was often asked to participate in panels and workshops about the best ways to confront vaccine hesitancy. I quickly became frustrated: the dearth of reliable data often resulted in a bunch of people relying on their intuition to determine the best way to convince parents that they shouldn’t rely on their intuition.

In 2012, when the American Academy of Arts and Sciences asked me to participate in another of these sessions, I got together with the Harvard School of Public Health’s Barry Bloom and the University of Washington’s Edgar Marcuse and proposed that the workshop focus on assembling a research agenda that would provide answers to a series of fundamental questions, including: How do parents learn about vaccines? To what extent does vaccine hesitancy result from a broader distrust in government? When are parents most receptive to information about vaccines? What are the best ways to present science-based recommendations, and what are the best ways to address specious fears?

A small number of academics are already trying to answer these types of questions.

Doug Opel at the University of Washington School of Medicine has videotaped pediatric visits in an effort to understand how physicians actually communicate about vaccines, and Saad Omer at the Emory Vaccine Center has conducted studies on how schools, health-care providers, and state-level legislation effect vaccine uptake. Heidi Larson of the London School of Tropical Medicine and Hygiene and Julie Leask from the University of Sydney’s National Centre for Immunisation Research and Surveillance are among a handful of others also doing excellent work.

But much more research is needed. High-quality social-science research, especially when it involves longitudinal studies designed to measure how people’s attitudes change over time, is expensive—but given that it costs upwards of ten thousand dollars to contain every single measles infection that occurs, that’s money well spent.

Seth Mnookin is an assistant professor of science writing at M.I.T. His most recent book is “The Panic Virus: The True Story Behind the Vaccine-Autism Controversy.”

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